Inpatient Dislocation After Primary Total Hip Arthroplasty.

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Public Health

Background:

• Inpatient dislocation after total hip arthroplasty (THA) is a costly complication and a "never event."
• While surgical technique influences dislocation risk, nontechnical factors require further investigation.
• Understanding patient and hospital characteristics is crucial for risk mitigation.

Purpose of the Study:

• To evaluate trends in inpatient dislocation after elective primary THA.
• To identify patient and hospital factors associated with THA dislocation.

Main Methods:

• Analysis of Nationwide Inpatient Sample discharge records (2002-2011).
• Assessment of temporal trends in dislocation rates.
• Multivariable logistic regression to identify associated factors.

Main Results:

• In-hospital dislocation rates increased from 0.025% to 0.15% between 2002 and 2011.
• Dislocations were associated with Black/Hispanic race/ethnicity, lower income, Medicaid insurance, and specific comorbidities (hemiparesis, psychosis, obesity).
• Fewer dislocations occurred at teaching hospitals and in the South.

Conclusions:

• The rate of in-hospital dislocation after primary THA is rising despite advances in care.
• Sociodemographic factors significantly influence dislocation risk, highlighting disparities.
• Interventions targeting social determinants of health may be more effective than technical improvements for reducing THA dislocations.